“The federal government has to account for states’ inability to sustain our current programs, much less expand,” said Kim Belshé, secretary of California’s Health and Human Services Agency.
I'm privileged to know PCPs from all over the country who are ready to give their all to their patients.
Their individual efforts to eliminate the barriers to access, to engage in highly personal individually attuned care that their patients need results in dramatic cost savings (see the example of Dr. M in Maine for instance - these are MaineCare (Medicaid) recipients).
These are the savings States and patients crave: savings from doing the right thing and delivering great care and improving the experience of care.
All the States have to do is to fully fund the work of effective primary care - shift ~ 5% of the health care cost wedge over to primary care and the total costs drop by 20-30% according to studies done in commercially insured populations. The potential savings in covering disadvantaged populations is larger given their propensity to use the emergency department when primary care access is poor (just ask Massachusetts).
So, States - you ready to work with practices to get the results you and your taxpayers want? Step up to the plate. You have to do two things:
- Fund the full scope of work of effective primary care. Small independent practices have demonstrated ability to do this work. Large institutional players might one day be able to perform at this level but tend to make very gradual/incremental change.
- Stop or drastically reduce the amount of administrative trivia that adds so much cost to practices and diverts staff time from needed patient care.
Don't pretend you're doing this just 'cause you have some Patient-Centered Medical Home project going - most don't come anywhere near to clearing the two aforementioned hurdles and most just tweak the status quo.
So, States: we know how to be accountable for high performing primary care. We have demonstrated this work in pilot studies. It gets better results and lowers cost beyond the limp and timid PCMH projects. We're ready to get to work. Are you?